ABSTRACT
Objective:To assess the prognos?c value of Intraabdominal Pressure in severe acute pancrea??s, compare it to APACHE II, to determine when to intervene based on intra abdominal pressure. Materials and Methods:We studied the role of intraabdominal pressure measurement as a prognos?c index and its applicability to determine the ?ming of interven?on in cases of severe acute pancrea??s as a prospec?ve cohort study from 2010- 2012, at Kamineni Hospital, L.B Nagar, Hyderabad. All pa?ents who were admi?ed with severe acute pancrea??s and consented to take part in the study were enrolled. All pa?ents were evaluated clinically, radiologically, biochemically and by the prognos?c indices – APACHE II, Ranson criteria and intra-abdominal pressure measurement. A total of 55 pa?ents were enrolled in this study. Intra-abdominal pressure was measured by intravesical technique using a Foley catheter.Intra-abdominal pressure was measured every 12 hours. Within 24 hours of admission, APACHE II score was obtained. Mul?variate analysis was u?lised for sta?s?cs. Results:Males comprised 73% of study popula?on. Mean age was 41.23± 13.74 years (17- 83 years). Ten pa?ents (18.81%) died. Among the non-survivors, the intraabdominal pressure (20.1± 3.1073 Vs 8.97± 4.39) and the APACHE II (17.5 ±4.09 Vs3.93 ±4.345),were significantly greater, P value <0.0001. The AUC for intra-abdominal pressureat 24 hours and at 72 hours was >0.7, which is highly significant. The sensi?vity for intra-abdominal pressure(>13 mm Hg) at 72 hours as a marker for mortality was 100%. Conclusion:The Intra-abdominal pressure monitoring is rapid, reproducible, inexpensive and minimally invasive, and can be used as a marker of the severity and prognosis of severe acute pancrea??s. Intra-abdominal pressure could poten?ally be used to guide the ?ming of interven?on. Compared to APACHE II, which is inclusive of mul?ple parameters, intra-abdominal pressure can serve the same purpose as a single prognos?c index. Further, we recommend a large, mul?centric studies to conclusively establish the predic?ve power of intra-abdominal pressure in acute pancrea??s and whether interven?ons known to reduce intraabdominal pressure, can alter the ul?mate outcome.